Hi everyone 👋,
Happy new year 🎊! Hope 2023 can be the Annus mirabilis for Long Covid & ME/CFS Research.
Welcome to everyone who recently subscribed within the last two weeks. Happy to announce that the newsletter eclipsed 1,000 subscribers! I want to personally thank everyone for the continued support, I never expected the newsletter to grow this quickly. As always, if you have any feedback to make the newsletter better, please feel free to reach out, I am very responsive to messages on Twitter or emails.
Without further ado, let’s jump in!
📰 Media
“An Explosion in Therapeutics”: the RECOVER Long COVID Biomarker Talk and Its Implications for Chronic Fatigue Syndrome and Fibromyalgia
🚨This is a great read! Definitely recommend checking it out.
From Healthrising:
Peluso compared the situation with long COVID now with the early stages of the HIV epidemic. They have some ideas about mechanistic biomarkers that can demonstrate how severe the illness is but no diagnostic, predictive, or surrogate biomarkers.
It took 15 years to find a surrogate marker for HIV, but Peluso believed that all these biomarkers – mechanistic, diagnostic, predictive, and surrogate – will be developed more quickly with long COVID (as well they should given the enormous growth of technology since then.)
Just as in the severe COVID-19 patients, they found evidence (zonulin or tight junction permeability) that the gut walls of the long-COVID patients had become leaky. Increased beta-glucan levels indicated that gut bacteria had made their way into the bloodstream. The fact that people with more gut bacteria in their blood had more symptoms indicated that leaky gut was clearly contributing to long COVID!
While the presenters didn’t mention it, with the exception of viral persistence, all these potential biomarkers have been found in ME/CFS/FM. Leaky gut is found, problems with tryptophan metabolism, and arterial stiffness have all been found – some over a decade ago – in these diseases as well.
Poorer people are getting a double dose of long COVID symptoms — Israeli research
From timeofisrael:
Low-income Israelis who have recovered [From Covid] averaged 3.3 symptoms, while higher-income Israelis averaged 1.8 symptoms,
“Policy-wise, our research indicates you need to target specific population groups and build infrastructure to deal with the expected health burden”
Novel Brain Imaging Study Seeks Answers to Chronic Fatigue and Fibromyalgia Mysteries
From Neuroscience News:
Lead researcher Dr. Zack Shan says the world-first research is using MRIs to track brain activity in around 300 study participants to determine how the brain controls its blood flow to match its energy needs, to better understand the disease process of fatigue-related illnesses.
Dr. Shan said that although the causes of ME/CFS and fibromyalgia remain unresolved, the well-documented impacts, including profound fatigue, sleep disturbance and cognitive impairments suggest that abnormal brain function plays a crucial role in the underlying disease process
Long COVID: Could mono virus or fat cells be playing roles?
From APNews:
Several studies suggest the ubiquitous Epstein-Barr virus could play a role in some cases of long COVID.
Inflammation caused by coronavirus infection can activate herpes viruses, which remain in the body after causing an acute infection
Stanford University researchers are among those who have found evidence that the coronavirus can infect fat cells. In a recent study, they found the virus and signs of inflammation in fat tissue taken from people who had died from COVID.
Lab tests showed that the virus can reproduce in fat tissue. That raises the possibility that fat tissue could serve as a “reservoir,” potentially fueling long COVID
There's a Powerful Link Between Chickenpox And Stroke Risk. We May Finally Know Why
From ScienceAlert:
People with shingles have an approximately 80 percent higher risk of stroke than those without the disease, and this risk stays elevated for up to a year after the rash has resolved.
In our recently published research, we found that VZV reactivation triggers the formation of cellular sacs, or exosomes, carrying proteins that contribute to blood clotting and inflammation.
An increase in these proteins may lead to an increased risk in stroke.
My Take: This is not necessarily covid related but I thought this was extremely noteworthy research. The mechanisms identified by these authors may be relevant to other viruses, as well. It is shocking to me how little we know about the post-sequelae of viruses 🦠 in 2022.
🔍 Research
Risk of incident heart failure after COVID-19 recovery: a systematic review and meta-analysis
From Springer:
Our results, based on a large population of more than 20 million people, demonstrated that COVID-19 recovery subjects had an additional 90% risk of developing HF (Heart Failure) within 9 months from the acute infection
Furthermore, the absence of any correlation with other cardiovascular risk factors or comorbidities suggested that the risk of incident HF might manifest even in subjects at relatively low cardiovascular risk
ME/CFS and Post-Exertional Malaise among Patients with Long COVID
From MDPI:
Among them, 272 (58%) met the CCC case definition for ME/CFS and 193 (42%) did not
On the outcome measure of functional impairment, with lower scores representing more severe impairment, those with ME/CFS scored … significantly lower than those not meeting ME/CFS criteria.
My take: As I have mentioned in previous newsletters, I definitely espouse segmenting Long Covid into different clusters. As this paper shows, a large segment of Long Covid sufferers have the criteria for ME/CFS.
An Elastic Net Regression Model for Identifying Long COVID Patients Using Health Administrative Data: A Population-Based Study
From Open Forum Infectious Diseases:
Long COVID patients in the development data set were more likely to be female (53.9%), aged between 50 and 59 years old (23.2%), and hospitalized for COVID-19-related reasons (44.0%) (Table 1). Prevalent conditions within the long COVID group included diabetes mellitus (22.8%), hypertension (32.7%), depression (43.4%), and mood and anxiety disorders (51.4%).
Our model identified 18% of our remaining population-based cohort of adult COVID-19 patients as probable long COVID cases. This is in line with published prevalence estimates of up to 20% within this population
🩺 Hope & Potential Treatments
Outpatient treatment of Covid-19 with metformin, ivermectin, and fluvoxamine and the development of Long Covid over 10-month follow-up
From medrxiv:
Overall, 10.6% of blinded control participants reported receiving a diagnosis of Long Covid from a medical provider, compared to 6.3% receiving metformin
*in which metformin showed a consistent direction of effect for preventing ED visits, hospitalizations, or death due to Covid-19, and hospitalizations or death through Day 14. ***There was no decreased incidence of Long Covid attributable to ivermectin or fluvoxamine in this trial.
My take: It is really encouraging to see research using already existing drugs. The lifecycle for a new drug to be commercially available is very long, it is entirely plausible an already existing drug may be repurposed.